Q: My doctor told me I have blood in my urine, but I have never seen it when I go to the bathroom. Can this be a problem?

A: Blood in the urine is not normal for anyone of any age. Some people might see a spot of blood in the urine stream, and women might see it when wiping after voiding. Others may see a full orange or red stream, and it can occasionally be so severe as to have true blood-clots in the urine. But for the vast majority, hematuria (the medical term for blood in the urine) is found by chance at the physician’s office on a routine check. While some of these scenarios are more unnerving than others, none of them is normal and all of them require treatment. If the bleeding is associated with the typical frequency, urgency and burning of a urinary infection, then the infection itself may be the cause of the bladder irritation. But there can be other bladder problems as well such as a bladder stone or even a bladder tumor or cancer. Because the kidneys manufacture the urine, we must evaluate the kidneys as well. Some kidney problems that can lead to bleeding include stones or a severe kidney inflammation, but occasionally there can even be a cancer within the kidney.

Patients who are at higher risk or having a problem are those who have a history of smoking (even is they quit 20 or 30 years ago) or those who have had chemical exposures in the workplace. Smokers don’t realize that the tobacco toxins may leave their lungs in 20 seconds, but the tar and nicotine products get processed in the blood and are cleansed b y the kidneys. These toxic waste products then sit in the bladder for hours before the person voids and this exposure greatly increases their risk for bladder cancer. This is just one more reason not to smoke.

The good news is that in the vast majority of patient we don’t find anything bad such as a tumor or cancer. But it is absolutely essential to have what generally is a brief evaluation of the kidneys with a sonogram or CT scan, and a visual inspection of the bladder in the office of a trained urologist.